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APPLICATION FOR �TRMI
HEATING - VENTIL`ATING - AIR CO I1'IONING
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT OF COUNTY ENGINEER ADDRESS Aw / r •-
BUILDING AND SAFETY DIVISION LOCALITY
NEAREST
CROSS ST.
FOR APPLICANT TO FILL-IN 'OWNER
(PRINT OR TYPE ONLY) 1 0. 0 ,t
MAI L
NO. TYPE&SIZE.OF EQUIPMENT FEE ADDRESS
SEE BACK OF APPLICATION
CITY TEL. NO.
FORCE AIR FURNPICE, BTU
�r CONTRACTOR iId
COMPRESSOR, BTU :_2
ADDRESS
VENTILATION FAN CITY a 'L. N
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LIST ALL OTHERS BELOW STAT
LICENSE NO. CLASS
DISTRICTNO. GROUP ZONE ,PROCESSED BY
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INSPftTION`ft COR O
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Plan check fee. See reverse.
11F:I1NIIT 1.S5I ISG FF,E g 3 00
PLAN CHECK APPLICANT
NAME
ADDRESS
CITY TEL.NO.
1 HEREBY ACKNOWLEDGE THAT I HAVE READ*THIS APPLICATION '
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY.,
WITH ALL ORDINANCES AND LAWS REGULATING HEATING, V.ENTI- APPROVALS- DATE INSPECTOR'S SIGNATURE
LAT ING,AIR CONDITIONING.
ROUGH
I HEREBY CERTIFY THAT I AM NOT ACTING IN VIOLATION
OF CHAPTER 9. DIVISION 3, OF THE BUSINESS AND PROFESSIONAL FINAL '
CODE OF THE STATE OF CALRNI ,
SIGNATURE . ,.dr+ PERMIT VALIDATION cK. M.0. CASH
OF PERMITTEE
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PLAN CHECK VALIDATION CK. M.O. CASH